Epidemiology and Risk Factors for Clostridium difficile Infection in Children

Sandora, Thomas J.; Fung, Monica; Flaherty, Kathleen R.; Helsing, Laura; Scanlon, Patricia; Potter-Bynoe, Gail; Gidengil, Courtney A.; Lee, Grace M.

doi:10.1097/inf.0b013e31820bfb29

Cited by 146 publications

(142 citation statements)

References 41 publications

(46 reference statements)

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“…Comparative studies of combination therapy and monotherapy have not specifically evaluated C. difficile infection as an outcome to draw conclusions regarding the increased risk, if one exists, with the addition of an aminoglycoside. Ample evidence exists, however, that fluoroquinolones are an independent risk factor for C. difficile infection (201,221).…”

Section: Clostridium Difficile Infectionmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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Section: Clostridium Difficile Infectionmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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“…High rates of C. difficile colonization have been well documented in infants less than 1 year of age (242)(243)(244)(245). Infants who are breastfed appear to have lower carriage rates (14%) than formula-fed infants (30%) (246).…”

Section: Special Patient Populations Childrenmentioning

confidence: 99%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

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SUMMARY Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile . This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

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“…Our finding that 71% of CDI pediatric cases are CA supports the reported increase in CA CDI among children in other studies. 19,20 These CA cases did not have an overnight stay in a health care facility, but 87% of them reported exposure to outpatient health care facilities before CDI, which may represent either the source of C difficile acquisition or where antibiotics were prescribed. Other sources of C difficile in the community have been speculated.…”

Section: Figurementioning

confidence: 99%

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

et al. 2014

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OBJECTIVE: Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups. METHODS: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010–2011 were used to identify cases (ie, residents with C difficile–positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years. RESULTS: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100 000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks. CONCLUSIONS: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

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Epidemiology and Risk Factors for Clostridium difficile Infection in Children

Abstract: Recent antibiotic exposure and certain comorbid conditions (solid organ transplant, presence of a gastrostomy or jejunostomy tube) were associated with CDI. Diagnostic testing has less utility in patients being treated with C. difficile-active antibiotics.

Cited by 146 publications

References 41 publications

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

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